Response To the Right Intervention (RTRI): Marrying Neurocognitive Science to RTI

In an excellent chapter, “Linking School Neuropsychological with Response to Intervention Models,” in Best Practices in School Psychology, Della Toffalo (2010) asserts that “…educationally relevant cognitive neuropsychological assessment…can and should occur at any time (any tier) in the RTI process when an intervention team has good reason to believe that standard protocol interventions may not be adequate to address the needs of an at-risk student (p.176).”

What does this mean? When IDEA was revised to include RTI as a way to establish eligibility for special education to correct the flaws of the ability discrepancy approach, it did not go far enough. That is, students who simply fail to be successful after a RTI plan should not be automatically considered to be learning disabled. First, this view of a learning disorder fails to include the universally accepted definition of a learning disability as including a processing deficit. Moreover, it just becomes another wait-to-fail model as students may proceed through tiers of intervention without the process being informed by cognitive processing information that could help in targeting students’ deficits earlier in the intervention process.

To elaborate, it is essential that the intervention team have available all tools that can diagnose students’ learning, behavioral, or emotional difficulties at any time (any tier). Della Toffalo includes a list of disorders involving learning disabilities which RTI alone may not be successful. It just makes no sense not to use all the neuropsychological tools available to identify the source of students’ learning and performance difficulties and to have this information drive the intervention process. Otherwise, the team is in danger of shooting from the hip, a practice that may inevitably lead to the failure of the prescribed interventions.

For example, academic subjects are byproducts of cognitive processing skills. Identifying and isolating those processes that are causing students’ problems can lead to more effective interventions. Does a students’ reading problem stem from a phonological or orthographic processing deficit? Are math problems due to a problem with memorizing basic math operations or the sequential steps to solve a word problem or to conceptual difficulties? This kind of specific knowledge about students’ issues is needed to craft an individually tailored plan. This kind of information can be obtained from the administration of specific subtests from a neuropsychological battery that are targeted to the areas of concern. In addition, this can all be done prior to going through four tiers when a full battery is needed. Of course, if a comprehensive evaluation is needed, it should be considered. However, RTRI can spare students and the intervention team a lot of time, effort, and pain.


Emotional Attunement in Teaching and Therapy: Some Things Do Not Change

As the fields of education and psychotherapy continue to evolve toward an increasing reliance on “evidence based practices,” it is of equal or even greater importance not to forget that the preponderance of the professional literature points to the importance of emotional attunement in teaching or in whatever form of therapy is being practiced. In our fast paced world, it may be easy to assign a lesser value to certain relationship variables that are prerequisites for making therapy work. Having a good enough relationship with students and patients provides the leverage that moves them to engage collaboratively on the road to accomplishing their goals.

Creating a relationship that will support teaching or therapy in good times and bad begins with a recognition of the immense power of induced emotion. That is, emotions are constantly being exchanged between therapists and teachers and their patients and students often nonverbally and without being noticed unless one is primed to recognize them. Just as we unknwoleingly catch colds, we also catch emotions. Strong emotions, positive or negative, need to be experienced, tolerated, and washed clean of any toxic elements that may derail the therapeutic or educational process. In a previous paper, I cited a quote from Sheldon Kopp who referenced a biblical saying: “If you want to raise a man from mud and filth, do not think it is enough to keep standing on top and reaching down to him a helping hand. You must go all the way down yourself, down into the mud and filth. You must not hesitate to get yourself dirty.” This is not an easy task. It means using the emotions being communicated in a personal way without personalizing them. When all feelings are tolerated and can be mirrored, then patients and students feel they are with someone who is like them. As a result, they are more likely to like you, and this makes the teaching or therapy “go.” Resisting the urge to take actions to deflect emotions that feel intolerable must be resisted because this amounts to rejecting the student or patient.

It is only through this process of embracing the emotional contagion that is part and parcel of every human relationship that we can return to those with whom we are engaged in an educational or therapeutic process an emotional communication that will move students or patients progressively forward.


Summer is Almost Here: A Perfect Time for a Neuropsychological Evaluation

If your student has had a difficult year, summer is the time to consider an evaluation to understand the roots of the difficulties and to develop a plan to address them in the fall in order to have a better next year.

Why a neuropsychological evaluation?

A neuropsychological evaluation is the most comprehensive assessment available. The scope of the evaluation is much broader than psycho-educational evaluations performed at school. Moreover, the choice of a test battery and the interpretation of the findings rely on a theoretical framework that represents the best science available.

What does a neuropsychological evaluation assess?

Academic subjects are comprised of neuropsychological processes including cognitive processing abilities and executive functions. The neuropsychological evaluation assesses these brain processes with a focus on understanding which of these is the cause of the academic or behavioral problem.

What kind of help can I expect to get from a neuropsychological evaluation?

The evaluation will examine each of the processing abilities and executive functions involved in performing successfully in each academic area. Once that information is obtained, an individualized instructional plan can be created that is tailored to each student’s neuropsychological profile. This will help teachers to differentiate instruction in a way that targets specific areas of deficit.

Why should I seek an evaluation from me?

First, I conduct all evaluations personally. I do not use a technician to perform the testing. This is important because the observations and interactions that occur during the test administration are very important parts of understanding your student. I believe the testing and the interpretation should be done by the same person. In addition, the reports I write are done personally after extensive analysis of the data and are not computer generated with reams of general and impractical recommendations.

Second, I have been conducting evaluations and working with children and adolescents for over 35 years. I know child and development and I know how to create a test battery that focuses on your student’s issues. My knowledge of the linkages between processing skills and academic performance and how to make realistic, practical, and reasonable recommendations has been obtained over three decades.

Third, I have intimate knowledge of how schools work and understand what kinds of recommendations they are able to implement and those they would ignore.

Fourth, I remain available after the evaluation to help you navigate the school system and child study team. I can accompany you to school meetings and help you in advocating for your student.